Medical Director - ENT

Job Description Summary Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer‑focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Remote Work This role is remote; work from home anywhere in the United States. Responsibilities Expand Aetna's medical management programs to address member needs across the continuum of care. Support Medical Management staff to ensure timely and consistent responses to members and providers. Lead all aspects of utilization review and quality assurance, directing case management. Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Be responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Required Qualifications 2 or more years of experience in the Health Care Delivery System, e.g., Clinical Practice and Health Care Industry. Active and current state medical license without encumbrances. M.D. or D.O. and Board Certification in Otolaryngology, with post‑graduate direct patient care experience. Preferred Qualifications Previous utilization management experience with a Health Plan or Payor. Education MD or DO required. Pay Range The typical pay range for this role is $174,070.00 – $374,920.00. This represents the base hourly rate or base annual full‑time salary for all positions in the job grade. The actual base salary offer will depend on factors such as experience, education, and geography. The position is also eligible for bonus, commission or short‑term incentive programs and an equity award target. Benefits This full‑time position offers a comprehensive benefits package, including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility. Application Deadline Application window closes on 06/30/2026. Equal Opportunity Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement